The Affordable Care Act’s coverage losses are no longer just an enrollment story. They are starting to affect how people manage their health, as newly uninsured patients skip prescriptions, delay specialist visits, and put off routine care they can no longer afford.
A KFF survey found that 9% of people who had marketplace coverage in 2025 are now uninsured, while another 17% are unsure they can afford premiums through the rest of 2026.
Urban Institute modeling projects 4.8 million more uninsured and $7.7 billion in new uncompensated care hitting providers. What began as an affordability cliff has become a health cliff for patients, doctors and hospitals.
Premiums rose 58%, and enrollees traded down to bare-bones plans
Aparna Soni, a health economist at Indiana University, documented the scope of the coverage erosion in an analysis published by The Conversation.
Marketplace enrollment fell from 21.8 million in February 2025 to 19.2 million one year later, a 12% decline, Soni reported.
Enrollees who stayed on marketplace plans absorbed steep cost increases across the board. Average monthly premium payments rose 58%, and deductibles climbed 37% to a record $3,786 per person, KFF reported.
Sabrina Corlette, Georgetown health policy professor, says steep deductibles undermine coverage.
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“And of course, when you have a deductible that’s like $6,000/$7,000 a year, it’s effectively being uninsured, because for a lot of folks, it’s easier to fly to the moon than pay a $6,000 deductible,” Corlette said.
To manage those costs, enrollees traded down to thinner coverage in large numbers. Bronze plan enrollment jumped from 30% to 40% of all selections, while silver plan sign-ups fell from 57% to a record low of 43%, KFF found.
The shift away from silver plans also reduced access to cost-sharing reductions, which are only available on silver-tier marketplace coverage.
Deductibles of $6,000 to $7,000 on many bronze plans effectively leave enrollees with insurance that offers minimal practical protection for routine care.
Research ties coverage gaps to emergency-room surges
Prior research warned that health consequences from coverage loss tend to materialize within weeks of a gap beginning. Emergency visits and hospitalizations for manageable conditions more than doubled within the first month after coverage lapsed.
Those surges involved diabetes complications, heart failure, and asthma exacerbations in particular.
After Tennessee removed 170,000 adults from its Medicaid program in 2005, those enrollees delayed and skipped necessary care because of cost, Soni reported in the analysis published by The Conversation.
They reported worse health outcomes in the years that followed, reinforcing the pattern now emerging at a national scale.
A 2021 study in The Quarterly Journal of Economics found that gaining Medicaid coverage under the ACA reduced mortality among older low-income adults by approximately 9.4%.
Corlette warned the worst may still lie ahead. In a statement to Marketplace, she predicted a “slow-moving train wreck” as enrollees continue dropping coverage throughout the year.
Coverage gaps are linked to sharp increases in emergency visits, skipped care, worsening conditions, and higher mortality among vulnerable adults.FS Productions / Getty Images
Hospitals face $7.7B in new uncompensated care costs
The financial burden is shifting from households to hospitals and safety-net providers across the country. Urban Institute researchers Fredric Blavin and Michael Simpson projected $7.7 billion in new uncompensated care demand for 2026.
Total health care spending would fall by $32.1 billion under the expired-credit scenario, the Urban Institute modeling found.
Hospital services would absorb a $14.2 billion reduction, and prescription drug spending would drop by $5.8 billion as patients skip or ration medications.
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The Urban Institute projected that 4.8 million people would lose coverage in 2026, a 21% increase in the national uninsured population.
Eight states, namely Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas, and West Virginia, face subsidized enrollment drops exceeding 50%.
Non-Hispanic Black populations face the largest proportional increase in uninsurance rates (about 30%), and among age groups, young adults ages 19–34 face the steepest rise (about 25%), the Urban Institute found.
KFF’s plan-selection data uses a slightly wider 18–34 bracket for its own tracking of sign-up declines.
Young adults and low-income households bear the steepest losses
The coverage losses are concentrated among populations that can least afford gaps in their care. Young adults ages 18 to 34 accounted for 542,000 fewer marketplace sign-ups, an 8% decrease that represented 46% of the total enrollment decline, KFF reported.
People in their late teens and twenties were twice as likely to drop coverage compared to enrollees over 50, the KFF survey found. More than half of all respondents told KFF they had cut household expenses to absorb the higher premiums.
Ashley Kirzinger, KFF’s director of survey methodology, told Marketplace that “people really value having health insurance and are willing to make significant lifestyle changes” to afford it.
Low-income households below 250% of the federal poverty level were hit hardest by the cost shift. Their average net premiums jumped from $169 to $919 per year under the expired credits, the Urban Institute found.
Soni’s research found that coverage gaps led directly to delayed maintenance medications and deferred specialist visits, producing worse outcomes when patients eventually sought care.
November’s open enrollment will be the earliest guaranteed re-entry point for most enrollees who lost marketplace coverage in 2026.
What uninsured patients can still do before November enrollment
For people who lost marketplace coverage, waiting until November can worsen both medical and financial risks. Skipped medications, delayed specialist visits and missed monitoring can turn manageable conditions into costly emergencies.
Those who lose coverage should explore Special Enrollment Periods, Medicaid, CHIP, or hardship exemptions and inform their doctors about any treatment gaps.
The ACA cliff is now shaping patient health, hospital costs and access to care nationwide, across communities.
Related: ACA health insurance premiums rise, force millions to drop coverage